Therapeutic Riding Research Articles

HORSE SPECIES SYMPOSIUM: Use of mesenchymal stem cells in fracture repair in horses.

Equine bone fractures are often catastrophic, potentially fatal, and costly to repair. Traditional methods of healing fractures have limited success, long recovery periods, and a high rate of reinjury. Current research in the equine industry has demonstrated that stem cell therapy is a promising novel therapy to improve fracture healing and reduce the incidence of reinjury; however, reports of success in horses have been variable and limited. Stem cells can be derived from embryonic, fetal, and adult tissue. Based on the ease of collection, opportunity for autologous cells, and proven success in other models, adipose- or bone marrow-derived mesenchymal stem cells (MSC) are often used in equine therapies. Methods for isolation, proliferation, and differentiation of MSC are well established in rodent and human models but are not well characterized in horses. There is recent evidence that equine bone marrow MSC are able to proliferate in culture for several passages in the presence of autologous and fetal bovine serum, which is important for expansion of cells. Mesenchymal stem cells have the capacity to differentiate into osteoblasts, the bone forming cells, and this complex process is regulated by a number of transcription factors including runt-related transcription factor 2 (Runx2) and osterix (Osx). However, it has not been well established if equine MSC are regulated in a similar manner. The data presented in this review support the view that equine bone marrow MSC are regulated by the same transcription factors that control the differentiation of rodent and human MSC into osteoblasts. Although stem cell therapy is promising in equine bone repair, additional research is needed to identify optimal methods for reintroduction and potential manipulations to improve their ability to form new bone.

Randomized Controlled Trial of Therapeutic Horseback Riding in Children and Adolescents With Autism Spectrum Disorder

Randomized Controlled Trial of Therapeutic Horseback Riding in Children and Adolescents With Autism Spectrum Disorder

Animal-Assisted Therapy With Chronic Psychiatric Inpatients: Equine-Assisted Psychotherapy and Aggressive Behavior

Animal-assisted therapy (AAT), most frequently used with dogs, is being used increasingly as an adjunctive alternative treatment for psychiatric patients. AAT with larger animals, such as horses, may have unique benefits. In this randomized controlled study, equine and canine forms of AAT were compared with standard treatments for hospitalized psychiatric patients to determine AAT effects on violent behavior and related measures. The study included 90 patients with recent in-hospital violent behavior or highly regressed behavior. Hospitalization at the 500-bed state psychiatric hospital was two months or longer (mean 5.4 years). Participants were randomly selected to receive ten weekly group therapy sessions of standardized equine-assisted psychotherapy (EAP), canine-assisted psychotherapy (CAP), enhanced social skills psychotherapy, or regular hospital care. Participants' mean age was 44, 37% were female, 76% had diagnoses of schizophrenia or schizoaffective disorder, and 56% had been committed involuntarily for civil or forensic reasons. Violence-related incident reports filed by staff in the three months after study intake were compared with reports two months preintake. Interventions were well tolerated. Analyses revealed an intervention group effect (F=3.00, df=3 and 86, p=.035); post hoc tests showed specific benefits of EAP (p<.05). Similar AAT effects were found for the incidence of 1:1 clinical observation (F=2.70, df=3 and 86, p=.051); post hoc tests suggested benefits of CAP (p=.058) as well as EAP (p=.082). Covariance analyses indicated that staff can predict which patients are likely to benefit from EAP (p=.01). AAT, and perhaps EAP uniquely, may be an effective therapeutic modality for long-term psychiatric patients at risk of violence.

The effects of horseback riding participation on the muscle tone and range of motion for children with spastic cerebral palsy.

The objective of this research is to verify the effects of horseback riding participation on the muscle tone of pelvic limbs and articular range of motion for children with spastic cerebral palsy. The research target is 16 children with spastic cerebral palsy, 8 children for the experimental group and 8 children for the control group. As a tool to measure the muscle tone, Modified Ashworth Scale (MAS), was used and a goniometer was used to measure the range of motion (ROM). A therapeutic horseback riding program was conducted to an experimental group of 8 children with spastic cerebral palsy in the therapeutic horseback riding for 60 min a day, 2 days a week and a total of 12 weeks. The results are as follows: First, the participation in the therapeutic horseback riding program showed a statistically significant difference in the muscle tone for the knee of children with spastic cerebral palsy (P< 0.01). Second, though the difference in knee muscle tone between the experimental group and the control group was statistically insignificant, the average was improved by the participation. Third, the participation in the therapeutic horseback riding program showed a statistically significant difference in the hip-joint motion range for the knee of children with spastic cerebral palsy (P< 0.01). Fourth, though the difference in the hip joint motion range between the experimental group and the control group was statistically insignificant, the average was improved by the participation.

Material de montaria para equoterapia em indivíduos com síndrome de Down: estudo eletromiográfico

Introdução: Os indivíduos com síndrome de Down apresentam características peculiares da anomalia, sendo a principal e mais frequente a hipotonia muscular. Objetivo: Verificar o melhor material de montaria e posicionamento dos pés para o recrutamento da musculatura de tronco de crianças com síndrome de Down que utilizam do tratamento da equoterapia. Métodos: Foram avaliados cinco praticantes com síndrome de Down por meio da eletromiografia, durante quatro sessões de equoterapia. Para análise estatística, foi utilizado o teste de Kruskal-Wallis para comparações múltiplas de dados não paramétricos. Resultados: O material de montaria de manta associado com os pés fora do estribo proporcionou maior recrutamento dos músculos estudados, sendo o músculo da região cervical o mais acionado. Conclusão: Por meio desse estudo piloto, infere-se que a manta com pés fora do estribo promoveu uma melhor otimização do tônus dos indivíduos analisados.

N05 A Brief Scale To Assess The Awareness Of Voluntary Movement

Background Physical therapy is advisable for Huntington’s disease. We offer myofunctional and motor coordination therapy, body awareness therapy and equine therapy. It seems that there’s an improvement of awareness of voluntary movement but it’s difficult to objectify. Aims We are developing a scale that includes 9 items trained in physical therapy. We describe preliminary results. Methods Items assess stability sitting on a chair, stability sitting on the floor, ability to get up safely from the floor, one-leg balance, sagittal balance, step quality, trajectory deviation, tandem gait, and drawing a circle in the air in the 3 planes of space. Total score ranges from 0 to 45. Motor, functional and cognitive assessments are reported. Results The scale has been applied to 11 patients. Their scores range from 20 to 42. Early HD (n = 1) scored 42 (one-leg balance and tandem gait were affected). Mid HD (n = 6) scored from 32 to 41 (one-leg balance, tandem gait, sagittal balance, step quality, and/or drawing a circle in the air were affected). Mid-late HD (n = 3) scored from 20 to 28 (besides previous items, get up safely from the floor, stability sitting on a chair, stability sitting on the floor, and/or trajectory deviation were affected). Up to now, we have applied the scale to 6 patients once they have completed the scheduled program: 4 patients (early and mid HD) improved at least 1 of the following items: one-leg balance, tandem gait, sagittal balance, step quality and drawing a circle in the air; 1 patient (mid-late HD) remained stable, and 1 (mid HD) worsened his one-leg balance. Conclusions We are aware that this sample is very small to obtain conclusions. There are some items that seem to improve after physical therapy. This study is open and we are willing to recruit more participants in order to assess if the scale could be sensitive enough to detect a change and to analyse if there’s correlation with well-validated scales.

Therapeutic horseback riding in breast cancer survivors: a pilot study.

To evaluate the physiologic and psychological effects of an equine-assisted therapy protocol (EAT) in breast cancer survivors. Twenty women (mean age, 45.61±2.71 years) whose breast cancer treatment had concluded at least 6 months previously underwent a screening protocol to certify their eligibility to participate in noncompetitive sports. The patients were randomly assigned to an intervention group (n=10) or a control group (n=10). Intervention patients participated in a 16-week EAT protocol consisting of 2 hours of activity per week. All patients were tested before and after the intervention for maximal oxygen consumption (VO2max), fat mass percentage, total body water percentage, strength of principal muscular groups (measured on five weight-lifting machines [leg press, leg extension, leg curl, shoulder press, vertical traction]), and quality of life using the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire (FACIT-F). After intervention, the intervention group showed an improvement in VO2max (28.29%; p<.001), a decrease in fat mass percentage (change, -7.73%; p<0.002), an increase in total body water percentage (6.90%; p=0.027), and an increase in strength (leg press, 17.75% [p=0.018]; leg extension, 21.55% [p=0.005]; leg curl, 26.04% [p<0.001]; shoulder press, 49.72% [p=0.003]; vertical traction, 19.27% [p=0.002]). Furthermore, the increase in the three FACIT-F scores (FACIT-F trial outcome: 9.29% [p=0.010]; Functional Assessment of Cancer Therapy-General total score, 14.80% [p=0.022]; FACIT-F total score, 11.48% [p=0.004]) showed an increase in quality of life. No significant changes for any variable were found for the control group. EAT had positive effects on both physiologic and psychological measures, enhancing quality of life of breast cancer survivors. RESULTS suggest a new method for rehabilitation intervention strategies after cancer in a nonmedical environment.

A horse of a different color.

Key termsequine; immunophenotype; ISCTmarkersThere has been growing interest in recent years in the use ofmesenchymal stem cells (MSCs) as a potential treatment fora number of important diseases. MSCs were first describedas colony-forming units consisting of fibroblast-like cellsderived from bone marrow (1). Since then they have beenisolated from many different tissues such as adipose, muscle,synovium, dental pulp, tendon, peripheral blood, Wharton’sjelly, and umbilical cord blood (2–4). The biological charac-teristics of MSCs that contribute to their therapeutic activityand the mechanisms of action continue to be studied.Despite many advances in MSC therapy, a specific markerthat defines cultured MSCs and identifies them within theirtissue niche has remained elusive. As a consequence, theInternational Society of Cell Therapy (ISCT) proposed a setof minimal test criteria for human MSCs as a first attempt atstandardization for laboratory and preclinical research. Thesecriteria include plastic adherence, trilineage differentiation toosteoblast, adipocyte, and chondrocyte lineages, and a phe-notype relating to surface marker expression. This latter stip-ulates that MSCs, measured by flow cytometry, must show 95% positivity for CD73, CD90, and CD105 antigens and 2% for CD45, CD34, CD14 or CD11b, CD79a or CD19,and HLA class II (5).These criteria were established only for human MSCresearch. However, the study of MSCs is not limited to humanapplications: many animal models are routinely used in pre-clinical investigation and in veterinary applications. There isan urgent need for a universal marker(s) to define and identifyMSCs from all tissues of origin, which will apply across allspecies.There has been an interest in equine MSC therapy formore than 10 years, especially in the treatment of musculo-skeletal disorders such as tendon or joint disease. In addition,because of similarities in terms of structure and biomechanics,the horse is accepted by the US Food and Drug Administra-tion as an animal model suitable for the investigation of carti-lage and tendon repair therapies for human use. In recentyears, several equine trials have been carried out using MSCsfrom different sources. Most of these reported a positive out-come (6) although the mechanism of action remains unclear.It can be argued that failure to understand the biologicalmechanism of repair hinders development of optimized thera-pies. It can also be argued that the lack of meaningful potencytests will hamper the development of standardized cell prepa-rations. The most important identifying characteristics ofequine MSCs have been plastic adhesion and trilineage poten-tial. The use of cell surface markers has been limited due tothe lack of commercial antibodies that cross-react with equineantigens (7).The paper published in this issue (p. XXX) by Paebstet al. is the first to analyze the complete panel of human MSCmarkers established by the ISCT in equine MSCs derived fromfive different tissue sources (marrow, adipose, tendon, umbili-cal cord tissue, and umbilical cord blood).

Equine Assisted Psychotherapy

This article describes the Equine Assisted Growth and Learning Association’s (EAGALA) experiential model called Equine Assisted Psychotherapy (EAP). EAGALA’s model is based on the Association for Experiential Education’s (AEE) tenets and is focused on the learner’s experience with horses. Drawing on the historical use of equines in the healing arts, we argue that EAP is distinct from other modalities that incorporate horses because it does not promote horseback riding or horsemanship skills. We outline the EAP model, drawing connections to the AEE’s principles of practice. Current research does not consistently include a common language when describing the program being investigated (sometimes not even referring to EAP or EAGALA). Therefore, this outline is needed to distinguish EAP from other models. Recommendations for future areas of inquiry include determining the degree to which EAP is effective and considering the specific variables central to its efficacy—including the characteristics of horses.

Equine Therapy in the Treatment of Female Eating Disorder

The article describes the preconditions and develops the hypothesis concerning the Equine therapy (EQT) is commonly used in the treatment of eating disorder (ED) inpatients, yet studies of its efficacy are lacking. This treatment outcome study therefore compares the efficacy of a standardized inpatient treatment protocol to standard treatment plus EQT among ED subjects. The sample include 72 women ED inpatients between ages 18 and 49, diagnosed with anorexia and bulimia nervosa and eating...

The Effects on Social Adaptability of Therapeutic Riding in Children with Intellectual Disabilities

The Effects on Social Adaptability of Therapeutic Riding in Children with Intellectual Disabilities

Quality of life in multiple sclerosis patients participating in therapeutic horseback riding

Introduction: Multiple Sclerosis (MS) is a disease that causes interferences in the quality of life (QoL) of affected individuals; for this reason, for this reason, programs of activities that can improve quality of life are crucial. Objective: Investigate whether therapeutic horseback riding (THR) included in the routine activities of people with MS promotes changes in perceived QoL. Methods: Fourteen individuals with MS were divided into intervention group and control group and assessed for perceived QoL by means of the Functional Assessment of Multiple Sclerosis (FAMS) instrument, before and after an interval of four months. Results: No significant changes in the QoL of MS subjects were observed, either in intragroup or intergroup assessments. Conclusion: The intervention with THR included in the routine therapeutic activities of individuals with MS was not helpful to promote changes in the perceived QoL of the individuals studied.

Efectividad de la terapia ecuestre en niños con retraso psicomotor

IntroductionEquine therapy, an intervention method that has been practiced for decades around the world, is used to treat patients susceptible to psychomotor delays. ObjectivesWe examine development of gross motor function compared to other psychomotor skills in patients undergoing this therapy, and analyse how this improvement affects general health status and quality of life. Material and methodsThe study includes 11 children with delayed psychomotor development (aged 8.82 ± 3.89; 6 boys, 5 girls). The main study variables were gross motor function (GMFM-88) and perceived quality of life (Pediatric Quality of Life Inventory, PedsQL). Three measurements were performed: before and after a period of inactivity, and once again 2 months after the second measurement, following completion of a sustained period of therapy. ResultsWe observed significant differences in overall results on the GMFM-88 between the initial and final tests and between the intermediate and final tests. Regarding the PedsQL quality of life scale, no statistically significant results were recorded. ConclusionsNoticeable changes in motor control were recorded throughout the course of the intervention, which suggests that equine therapy may be appropriate treatment in cases of delayed psychomotor development.

Willingness of a Convenience Sample of Horse Owners to Use Stem Cell Therapy for the Treatment of Equine Tendon Injury and Factors that Influence This Decision

Stem cell therapies offer huge potential for the treatment of tendon injury in horses. However, the factors influencing clients' willingness to use these therapies have not yet been investigated. This study examines the willingness of a population of horse owners to choose stem cell therapy for the treatment of equine tendon injuries and the factors that may influence this choice including treatment cost and efficacy, veterinarian advice, client knowledge, and success stories. A short, anonymous questionnaire was delivered to a convenience sample of equine owners. Questions related to (1) respondent background; (2) prior experience with tendon injuries and their treatment; (3) willingness to use equine stem cell therapy; and (4) the importance of factors that may affect their decision to use the therapy. Responses were summarized using graphical methods and compared using Fisher exact test where appropriate. Fifty-four percent of our cohort (n = 113) reported they would be willing to use equine stem cell therapy, 6% were not willing, and 40% were unsure. When asked to rank factors that would influence their decision, scientific proof that the therapy works was ranked highest followed by veterinarian advice. This result may have been influenced by the high proportion of tertiary-educated respondents recruited in this study. This is the first reported study to investigate the willingness of a population of horse owners to use stem cell therapy for their horses. Results suggest that the majority of these equine owners may consider using stem cell therapies for their horses given a larger positive evidence base was provided for the therapy.

Commentary on

“How could I apply this information?” This study describes qualitative feedback provided by children and parents regarding their experiences with equine-assisted therapies and activities (EATA). By describing the benefits, relationships, and barriers faced by the study participants, the authors present actionable issues that can be used by clinicians to maximize the potential therapeutic benefit during the EATA sessions. The study results highlight the important concept of self-efficacy as it relates to motor learning. Improved feelings of self-efficacy, personal beliefs about ability, and related expectations have been supported in many prior studies and are important to incorporate into rehabilitation.1 “What should I be mindful about in applying this information?” Expanding on these qualitative results with quantitative metrics of function would further clarify outcomes from EATA and possibly provide insight into mechanisms that support change following EATA. It is important to distinguish between equine-assisted activities that are therapeutic in nature, that is, provided by a licensed physical, occupational, or speech therapist, and those that are recreational in nature.2 Hippotherapy, provided by a licensed PT, OT, or SLP, should be billed as a therapeutic intervention and therefore address the cost barrier that has been identified. Should the patient not be expected to make functional gains but is interested in equine-assisted activities as a means to improve quality of life, and maintain present functional level of core strength, breathing, and postural control, a recreational program of therapeutic riding could be chosen; however, this may not be supported by insurance or other payers. The importance of improved self-efficacy, or ability to perform functional motor tasks, especially in a child with a disease that is progressive in nature, may be paramount to the individual's quality of life. Cassandra Sanders-Holly, PT, DPT, PCS Leaps & Bounds Pediatric Therapy Inc Norco, California Eric Wade, PhD Department of Mechanical, Aerospace, and Biomedical Engineering University of Tennessee, Knoxville Knoxville, Tennessee

Effects of Therapeutic Riding in Children with Spastic Cerebral Palsy

This study examined the effect of therapeutic horseback riding in children with spastic cerebral palsy. Participants were placed in a therapeutic riding (TR) group (n=7) or physical therapy (PT) group (n=7). This study was then conducted for 30 minutes, twice a week, for 8 weeks. The gross motor function measure (GMFM), range of motion (ROM), and spasticity test (ST) were analyzed pre-test (TR0 and PT0), mid-test (TR1 and PT1), and post-test (TR2 and PT2). We used the SPSS 12.0 statistical software for data analysis. We observed significant changes in GMFM Dimension C (crawling and kneeling), D (standing), and E (walking, running, and jumping) between TR2 and TR0 (P < 0.05). In the control group, GMFM Dimension B (sitting) and E showed significant changes between PT2 compared to PT0 (P < 0.05). In future studies we will consider using a therapeutic riding program for the treatment of children with disorders.

Hypotheses about the Psychological Benefits of Horses

In the last few decades, therapeutic horse-riding has become recognized as a progressive form of therapy, particularly for people with disabilities. Although there is a substantial amount of literature that supports the physical benefit of therapeutic riding, only anecdotal evidence exists in relation to its psychological benefits. The purpose of this article is to develop hypotheses about the mechanisms by which therapeutic riding might have a beneficial psychological effect. These hypotheses can then be tested, leading to a more detailed knowledge base. PsychINFO, MEDLINE, PROQUEST, Scopus, Web of Science, and CINAHL. Data sources were searched for studies that (a) were related to the psychological effects of therapeutic horse-riding, (b) focused exclusively on therapeutic horse-riding, (c) described, explicitly or implicitly, the mechanism by which therapeutic riding had a beneficial psychological effect. Studies were limited to those published between 2008 and 2012. Data were extracted by two authors independently. Thirty articles met the inclusion criteria. Three potential hypotheses emerged from the literature, namely, (1) the psychological benefits of therapeutic riding are actually unrelated to the horse, (2) the horse provides a particularly positive context within which psychological gains are facilitated, and (3) the horse itself has specific therapeutic qualities that bring about unique changes not otherwise likely to occur. The challenge for researchers in this area is to design studies that adequately test these competing hypotheses.

Uplatnění paravoltiže v rámci léčebné hipoterapie

Paravaulting or acrobatics on the horseback is one of many rehabilitation methods based on therapeutic riding and is a sports event for people with disabilities. Paravaulting is basically identical to the vaulting but is tailored to individuals with disabilities. The aim was to design a regular motor preparation for training paravaulting which has not been written till present. Gymnastic exercises were included in the training unit of paravaulting. Workouts are designed to improve orientation, balance and overall agility. During applying gymnastic exercises in motion program had to be based on information that the focus had to match the mental abilities of individual probands, their condition and specifics of disability.

Therapeutic Horseback Riding Outcomes of Parent-Identified Goals for Children with Autism Spectrum Disorder: An ABA′ Multiple Case Design Examining Dosing and Generalization to the Home and Community

We examined whether different doses of therapeutic riding influenced parent-nominated target behaviors of children with autism spectrum disorder (ASD) (a) during the session (b) at home, and (c) in the community. We used a single subject multiple Baseline, multiple case design, with dosing of 1, 3, and 5 times/week. Three boys with ASD, 6-8 years of age participated, and counts of target behaviors were collected in each setting and phase of the study. Compared to Baseline, 70% of the target behaviors were better during Intervention and improvement was retained in 63% of the behaviors during Withdrawal. Increased doses of therapeutic riding were significant for magnitude of change, and the effect of the therapeutic riding sessions generalized to home and community.

Equine-Assisted Psychotherapy as a Creative Relational Approach to Treating Clients With Eating Disorders

The increased prevalence of reported eating disorders, in conjunction with their potentially fatal consequences, is a current mental health concern. Development and maintenance of body image, weight, and concerns around eating often stem from individuals’ various relational and cultural environments. We provide a discussion of Gestalt equine-assisted psychotherapy as a creative relational approach to eating disorder treatment and introduce a case example that illustrates the use and benefits of equine-assisted therapy with clients who have an eating disorder. A brief overview of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition diagnostic terms and criteria is also included. PERSPECTIVES FROM THE FIELD is a special feature included in this issue of the Journal of Creativity in Mental Health that provides mental health professionals with an opportunity to discuss their positions on a variety of creativity-related topics. In this issue, authors share two different perspectives on conceptualization of and treatment approaches to clients with eating disorders. Veronica Lac, Erin Marble, and Ioana Boie discuss the creative relational approach of Gestalt-informed equine-assisted psychotherapy. Jonathan Matusitz and Jacqueline Martin explore the role of self-determination theory in the development and maintenance of disordered eating and distorted body image, and discuss how mental health professionals can offer effective treatment. Both perspectives offer unique insights into the conceptualization and treatment of eating disorders.